News headlines

A selection of news stories which have appeared since March 1 2004 at http://www.aidsmap.com.

 US treatment guidelines updated

The US Department of Health and Human Services has updated its adult antiretroviral treatment guidelines.

 HAART takes more than a year to suppress Kaposi's sarcoma virus

Anti-HIV medications can completely suppress Kaposi's sarcoma-associated herpes virus (KSHV) (the virus that causes KS, one of the AIDS-defining cancers) but take at least twelve months to do so, providing an explanation for the remarkable decline in KS seen in resource-rich nations in the post-HAART era, according to an article published in the March 5th issue of AIDS.

 Kidney stones and other calculus build-up seen in 4% of those on Kaletra-based HAART

Kaletra-associated kidney stones and lithiasis (calculus build-up) have been reported in the March 5th issue of AIDS. Doctors at the Departments of Infectious Diseases and Pharmacology at CHU Nancy, France, report that seven of 165 individuals (4%) experienced either the formation of calculus (e.g. kidney stones), or intense urinary pain on Kaletra-based HAART.

Need for new TB test highlighted on World TB Day

International efforts to combat TB are falling short, despite optimistic statements by the World Health Organisation, because of an international failure to detect TB cases and provide prompt treatment, it emerged today at the Stop TB Partners Fourm in New Delhi, India.

 Can HAART prevent SARS?

HAART should be used to treat and prevent Severe Acute Respiratory Syndrome (SARS) when the next epidemic emerges (a possibility considered likely by many SARS experts) according to an article in the April 1st issue of Clinical Infectious Diseases, which was published online last week.

 CSF abnormalities less likely to normalise in HIV-positive patients treated for neurosyphilis

A key laboratory marker used to measure the success of antibiotic treatment for neurosyphilis is significantly more likely to be abnormal in HIV-positive individuals, particularly those with a low CD4 cell count, than in patients who do not have HIV, according to research published in the April 1st edition of Clinical Infectious Diseases, which is now available on-line.

Kaletra may cause fewer lipid abnormalities than previously thought in HIV-positive

The use of the boosted protease inhibitor Kaletra (lopinavir/ritonavir) causes an increase in triglyceride and total cholesterol levels, according to a Spanish study which monitored blood lipids in individuals taking the drug after an overnight fast. However, the study found fewer Kaletra-treated individuals with elevated blood lipids than were found in the clinical trials which led to the drug's approval, and the investigators found that the strongest risk factor for the development of abnormal lipids whilst taking Kaletra was the presence of elevated blood fats when treatment with the drug was commenced. The study is published in the April 1st edition of Clinical Infectious Diseases, and is now available on-line.

Kaletra leads to significant increases in some blood lipids in HIV-negative men

A study involving HIV-negative men has found that taking Kaletra can result in significant increases in some blood lipids, and suggests that the metabolic effects of protease inhibitors are drug-specific rather than a class effect. The study is published in the March 5th edition of AIDS.

Cheap tests good predictors of disease progression after starting HAART

Inexpensive blood tests to measure total lymphocyte count, haemoglobin levels, and response to antigens can accurately predict the risk of HIV disease progression and could be used as a tool to monitor the effectiveness of HAART in resource-limited settings, according to a study published in the April 1st edition of the Journal of Acquired Immune Deficiency Syndromes. In particular, the study found that the response to HAART was poorer in women who started HAART with total lymphocyte counts below 850 cells/mm³.

Unexpected CD4 declines seen on full dose ddI with tenofovir

An unexpected significant fall in CD4, CD8 and total lymphocyte counts has been seen in people combining full dose ddI with tenofovir, according to a study from Spain published in a recent edition of the journal AIDS.

Regions with fastest growing HIV epidemics have worst rates of MDR-TB says WHO

The regions of the world with the fastest growing HIV epidemics also have the highest rates of multidrug-resistant tuberculosis (MDR-TB), according to a World Health Organisation (WHO) report published on March 16th. In particular, many of the former Soviet republics, China, and South Africa were identified as key areas with a particularly high prevalence of MDR-TB.

Tenofovir/FTC once daily tablet ready by 2005

A tablet combining tenofovir and FTC (emtricitabine) is likely to be available for prescription in Europe and the United States by the beginning of 2005, following today's announcement by Gilead Sciences that it has applied for marketing approval in the European Union and the United States.

30% of mother to child HIV infections occur in the womb

Up to one-third of mother to child HIV transmission is not being addressed by current interventions being implemented in resource-limited settings because no attempt is being made to prevent viral transmission whilst the infant is still in the womb, according to a study published in the journal AIDS and carried out by researchers from the University of Zimbabwe and various north American institutions.

•  Women worldwide carrying burden of AIDS, says UN's Annan

Secretary General Kofi Annan marked International Women's Day on Monday by highlighting the increasing numbers of girls and women living with - and becoming infected by - HIV.

•  HIV leads to rise in TB incidence in both HIV-positive and HIV-negative SA gold miners

HIV has led to an increase in new tuberculosis (TB) infections, not only in individuals with HIV, but also in HIV-negative individuals, according to a cohort study involving South African gold miners published in the March 5th edition of AIDS.

•  NRTI toxicity may be associated with increased cellular activation due to advanced disease

Researchers from the University of Colorado have a proposed a new explanation for why people with advanced HIV disease tend to suffer more serious toxicities when treated with drug combinations that include nucleoside analogues. Writing in the March 1st edition of Clinical Infectious Diseases, they reason that excessive intracellular concentrations of phosphorylated NRTIs might be responsible for the disruption of mitochondrial processes and the consequent toxicities observed in affected tissues. Furthermore, they propose that increased cellular activation as a result of advanced HIV disease may be responsible for the over-production of NRTI phosphates, which are then shuttled into the mitochondria in preference to normal nucleotides.

•  Life-threatening allergic reaction after a single dose of abacavir reported

A patient developed a potentially life-threatening hypersensitivity reaction to the nucleoside analogue (NRTI) abacavir (Ziagen) after receiving a single dose of the drug. The case is reported in a letter in the February 20th edition of AIDS.

•  UK to give £3 million to WHO 3 x 5 programme

The United Kingdom is to give £3 million (US$5 million) to the World Health Organisation to help it achieve its 3 x 5 programme of work, the Department for International Development (DFID) announced today.

•  UN AIDS envoy raises alarm over funding for 3 x 5; 98% shortfall for 2004

The World Health Organisation's bid to get three million people onto treatment by the end of 2005 is stalled because of lack of financial support for WHO from the world's richest countries, according to the UN's Special Envoy on AIDS, Stephen Lewis. He said only three nations - Spain, Sweden and the United Kingdom - have indicated any willingness to give money to WHO that will allow it to carry out its 3 x 5 programme of work.

•  Girls twice as likely as boys to get HIV from their mothers in the womb

Girls are twice as likely as boys to be infected with HIV in their mothers' wombs, according to a European study published in the January 23rd edition of AIDS. Investigators believe that this may be because of genetic differences between the sexes, as well as different immunological responses, and could explain why infant girls have consistently lower viral loads than boys.

AIDSpan Guide to applying to the Global Fund

The Aidspan Guide to Applying to the Global Fund was published earlier this month. It is accessible at http://www.aidspan.org/guides, where the "Aidspan Guide to Obtaining Global Fund-Related Technical Assistance" is already available.

Chapter 1 includes sections on "Are you an Eligible Applicant?", "Are you Ready to Apply?", "Some Key Concepts to be Used in all Applications", and "Some Warnings." Chapter 2, which is based on an analysis of TRP comments, reviews the most common strengths and weaknesses of proposals submitted to the Global Fund in Round 3. Finally, Chapter 3 consists of a step-by-step guide to filling out the proposal form.

Chapter 3 includes an up-to-the-minute evaluation of the different methods whereby applicants can send their application data to the Global Fund. (One week ago, GFO commented on some technical problems that users of the online version of the application form were encountering.)

New HIV clinical training resource available from Impact/Family Health International

A new facilitator's guide for training physicians, nurses and other health care workers to treat people with HIV/AIDS in developing countries is now available. "HIV/AIDS Care and Treatment: A Clinical Course for People Caring for Persons Living with HIV/AIDS" features facilitator's notes to guide the training process. An accompanying CD-Rom contains PowerPoint slides and notes for course participants.

This course is designed to address one of the greatest challenges to rapidly scaling-up antiretroviral therapy and care and support services in resource-constrained settings: training health workers to treat HIV-related conditions. The 436-page facilitator's guide covers the most important elements of care and treatment, including antiretroviral therapy, and addresses special issues related to women, young children, and people co-infected with tuberculosis.

The state-of-the-art book was produced by the Implementing AIDS Prevention and Care (IMPACT) Project, which is funded by the US. Agency for International Development and managed by Family Health International (FHI).

FHI has worked in collaboration with ministries of health and community-based organizations to build capacity for comprehensive HIV/AIDS treatment, care and support services. In Ghana, Kenya and Rwanda, FHI provides ART as part of a spectrum of comprehensive care services with support from USAID and the UK's Department for International Development.

The facilitator's guide and participant's manual are available in electronic form at the Family Health International website

Hard copies are available free to users in developing countries. To request one, please send complete mailing address to: aidspubs@fhi.org